Objectives: Diabetic-ketoacidosis (DKA) is a life-threatening complication and a leading cause of hospitalization in Type-1-diabetes (T1DM) patients. We aimed to assess the risk factors of admissions of children with DKA in a specialized children hospital in order to reduce morbidity and to inform appropriate prevention and intervention strategies. Methods: A retrospective review of all DKA admissions at King Abdullah Specialized Children’s Hospital, Riyadh (March 2015–December 2017). Data were gathered from newly diagnosed of T1DM and known patients ≤14-year-old with DKA criteria. The main variables were frequency, precipitating factors, and other characteristics of DKA admissions in both groups. Results: A total of 116/562 patients with T1DM (mean age 8.97±3.08 years) had 146 DKA episodes, of which 26/116 (34%) were newly diagnosed. The frequency of DKA admissions 2 were 146/562, 26%, of which (n=42/146, 28.7%) were newly diagnosed vs. (n=104/146, 71.2%) known patient of T1DM. The majority were 10-14 years (p≤0.001) and 55.5% were females. Missing insulin was the main precipitating cause of DKA (p=0.001) among known patients with T1DM. Recurrent episodes (n=30/164, 20.5%) occurred in 15/116 patients and were more common in children ≥10 years of age (P=0.024). The mean length-of-stay was 2.67±2.04 days and increased with DKA severity (P=0.008). Conclusions: In our study, the majority of DKA episodes were in patients with known T1DM; and missing insulin was the leading cause of DKA. In addition to awareness campaigns to prevent DKA as an initial presentation, intervention strategies should also target high risk groups of known patients of T1DM such as adolescents and patients with recurrent episodes.